Predictors of Residual Renal Function Decline in Peritoneal Dialysis Patients: ThebalANZ Trial

2017 ◽  
Vol 37 (3) ◽  
pp. 283-289 ◽  
Author(s):  
Htay Htay ◽  
Yeoungjee Cho ◽  
Elaine M. Pascoe ◽  
Darsy Darssan ◽  
Carmel Hawley ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Demographic Data ◽  
Urine Volume ◽  
Renin Angiotensin System ◽  
Residual Renal Function ◽  
Angiotensin System ◽  
Low Glucose ◽  
Glucose Exposure

ObjectivePreservation of residual renal function (RRF) is associated with improved survival. The aim of the present study was to identify independent predictors of RRF and urine volume (UV) in incident peritoneal dialysis (PD) patients.MethodsThe study included incident PD patients who were balANZ trial participants. The primary and secondary outcomes were RRF and UV, respectively. Both outcomes were analyzed using mixed effects linear regression with demographic data in the first model and PD-related parameters included in a second model.ResultsThe study included 161 patients (mean age 57.9 ± 14.1 years, 44% female, 33% diabetic, mean follow-up 19.5 ± 6.6 months). Residual renal function declined from 7.5 ± 2.9 mL/min/1.73 m2at baseline to 3.3 ± 2.8 mL/min/1.73 m2at 24 months. Better preservation of RRF was independently predicted by male gender, higher baseline RRF, higher time-varying systolic blood pressure (SBP), biocompatible (neutral pH, low glucose degradation product) PD solution, lower peritoneal ultrafiltration (UF) and lower dialysate glucose exposure. In particular, biocompatible solution resulted in 27% better RRF preservation. Each 1 L/day increase in UF was associated with 8% worse RRF preservation ( p = 0.007) and each 10 g/day increase in dialysate glucose exposure was associated with 4% worse RRF preservation ( p < 0.001). Residual renal function was not independently predicted by body mass index, diabetes mellitus, renin angiotensin system inhibitors, peritoneal solute transport rate, or PD modality. Similar results were observed for UV.ConclusionsCommon modifiable risk factors which were consistently associated with preserved RRF and residual UV were use of biocompatible PD solutions and achievement of higher SBP, lower peritoneal UF, and lower dialysate glucose exposure over time.

Risk factors for loss of residual renal function in children with end-stage renal disease undergoing automatic peritoneal dialysis

2020 ◽  
Vol 40 (4) ◽  
pp. 368-376
Author(s):  
Qian Shen ◽  
XiaoYan Fang ◽  
YiHui Zhai ◽  
Jia Rao ◽  
Jing Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
End Stage Renal Disease ◽  
Urine Volume ◽  
Residual Renal Function ◽  
Daily Urine ◽  
Glucose Exposure ◽  
Stage Renal Disease ◽  
End Stage

Background: This study analysed children with end-stage renal disease treated with automated peritoneal dialysis (APD) in our centre to explore the risk factors associated with residual renal function (RRF) loss. Methods: Children treated with APD as the initial renal replacement therapy regimen from January 2008 to December 2016 were included. All the children had a daily urine volume of ≥100 ml/m2 when APD was initiated and a dialysis follow-up time of ≥12 months. A daily urine volume of <100 ml/m2 after 12 months of APD treatment was defined as loss of RRF. Possible risk factors that may be associated with RRF loss were analysed. Results: A total of 66 children were included in the study. After 12 months of APD treatment, the daily urine volume decreased by 377.45 ± 348.80 ml/m2, the residual glomerular filtration rate decreased by 6.39 ± 3.69 ml/min/1.73 m2 and 29 of the patients (43.9%) developed RRF loss. The higher risk of RRF loss after 1 year of APD treatment was most pronounced in patients with daily urine volume of ≤400 ml/m2 before treatment, higher glucose exposure and higher ultrafiltration volume, while the lower risk of RRF loss was in patients with administration of diuretics. Each increase of 1 g/m2/day glucose exposure was associated with a 5% increase in RRF loss (odds ratio (OR) 1.05, p = 0.023) and each increase of 1 ml/m2/day ultrafiltration volume was associated with a 1% increase in RRF loss (OR 1.01, p = 0.013). Conclusion: In children undergoing APD, the risk for loss of RRF is associated with low urine volume at the start of APD, high glucose loading and high peritoneal ultrafiltration volume, while preservation of RRF is associated with the usage of diuretics.

scholarly journals P1135WHETHER USPD PATIENTS ARE SUITABLE FOR INCREMENTAL PERITONEAL DIALYSIS:YES OR NO?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Wenjing Zhang ◽  
Jia LV ◽  
Lan Li ◽  
Zhigang Wang ◽  
Dapeng Hao ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Urine Volume ◽  
Residual Renal Function ◽  
Dialysis Dose ◽  
Dialysis Adequacy ◽  
Exit Site Infection ◽  
Full Dose ◽  
Mechanical Complications

Abstract Background and Aims Incremental Peritoneal Dialysis (IPD) is the practice of initiating PD exchange less than four times a day in consideration of residual renal function (RRF). More clinical studies have confirmed the feasibility and effectiveness of IPD, especially in the protection of residual renal function, which is obviously superior to full-dose PD. Urgent-start peritoneal dialysis (USPD) is a popular PD method. Due to lack of pre-dialysis education, most of patients who were newly diagnosed with ESRD in China chose USPD. Well, can incremental peritoneal dialysis be used for USPD patients when starting dialysis? Compared to full-dose PD, whether incremental PD affects the residual renal function in USPD patients? Here we report the first study of incremental peritoneal dialysis’s effect on residual renal function. Method A retrospective analysis of medical records was performed on 169 patients who received USPD from August 2008 to March 2017. Patients were divided into 2 groups according to dialysis dose: incremental PD(i-PD) group (dialysis dose were less than or equal to 6000ml or 3 exchanges per day) and full-dose PD(f-PD) group (dialysis dose were great than or equal to 8000ml or 4 exchanges per day). The demographics, clinical biochemical indexes, dialysis dose, urine volume, dialysis ultrafiltration volume, RRF, dialysis adequacy, peritoneal dialysis infection complications, mechanical complications and survival rates were compared between two groups in 1 year follow-up. Results: (1).A total of 169 patients were enrolled, including 111 patients (average age 45.01±12.84 years) in i-PD group and 58 patients (average age 43.5±15.62 years) in f-PD group. The demographics and clinical biochemical indexes in the two groups before peritoneal dialysis were similar (P&gt;0.05). (2).During the follow-up period, the dialysis dose in f-PD group(8034.48±262.61ml/d, 8080.00±395.80ml/d, 8155.17±523.21ml/d, 8051.72±906.55ml/d) were more than those in i-PD group(5891.89±528.31ml/d, 6159.57±1185.06ml/d, 6468.47±1588.71ml/d, 6900.90±1543.05ml/d), P&lt;0.05. And the dialysis adequacy in both groups were up to standard: the total Kt/V (i-PD group: 1.96±0.56, 2.01±0.70, 2.02±0.55, 1.90±0.52; f-PD group: 2.18±0.47, 2.22±0.55, 2.05±0.44, 2.03±0.42) were greater than 1.7 and the total Ccr (i-PD group: 79.39±29.75, 79.02±25.11, 78.26±30.00, 73.09±29.14; f-PD group: 89.78±29.89, 91.54±35.56, 82.38±29.27, 72.96±23.75) were greater than 60L. (3).During the whole follow-up period, the residual renal function between two groups had no statistically significant(i-PD group: 3.96±2.52ml/min, 3.46±1.95ml/min, 3.58±2.85ml/min, 2.91±2.33ml/min; f-PD group: 4.31±4.83ml/min, 3.45±2.36ml/min, 3.16±2.15ml/min, 2.36±1.65ml/min), P&gt;0.05. (4).During the whole follow-up period, the blood pressure control, correction of anemia, and correction of calcium and phosphorus abnormalities were also similar in both groups, P&gt;0.05. (5).At 1-month and 6-month, the urine volume were higher in i-PD group(1024.33±492.91ml/d, 1017.03±571.66ml/d) than those in f-PD group(782.93±415.89ml/d, 788.27±491.02ml/d), P&lt;0.05. The dialysis ultrafiltration volume in f-PD group (481.67±723.69ml/d, 632.77±687.89ml/d, 338.87±963.14ml/d, 750.43±849.69ml/d) were higher than those in i-PD group(343.30±520.00ml/d, 495.70±916.76ml/d, 341.78±925.57ml/d, 439.65±1297.13ml/d) during the whole follow-up period, but the differences were not statistically significant (P&gt;0.05). (6).The exit-site infection, peritonitis, mechanical complications and technical survival were similar between the two groups (P&gt;0.05). Conclusion Incremental peritoneal dialysis will not cause rapid decline of residual renal function in USPD patients, and the dialysis effect and complications are similar to full-dose peritoneal dialysis. Therefore, we recommend that USPD patients can be treated by incremental peritoneal dialysis.

scholarly journals P1154EFFECTS OF SHORT-TERM HEMODIALYSIS WITH CENTRAL VENOUS CATHETER(HD-CVC) ON PATIENTS WITH URGENT-START PERITONEAL DIALYSIS(USPD)

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Wenjing Zhang ◽  
Jia LV ◽  
Zhigang Wang ◽  
Lan Li ◽  
Jiping Sun
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Central Venous Catheter ◽  
Urine Volume ◽  
Venous Catheter ◽  
Residual Renal Function ◽  
Central Venous ◽  
Short Term ◽  
Dialysis Adequacy

Abstract Background and Aims Urgent-start peritoneal dialysis (USPD) has gained increasing worldwide attention. Studies have suggested that USPD has many advantages concerning the early complications, survival rates and medical expenses. Due to the lack of pre-dialysis education, most patients newly diagnosed with ESRD in China have less knowledge about the dialysis methods, whether HD or PD. So, some patients choose to receive the short-term hemodialysis with central venous catheter (HD-CVC) before USPD. Whether the HD-CVC affected USPD, and whether it was necessary for ESRD patients without indications of emergency dialysis to undergo HD-CVC transition before USPD, were addressed. So we investigate the effects of the HD-CVC on urgent-start peritoneal dialysis. Method Retrospective analysis was performed on patients who received USPD from August 2008 to March 2017 in the first affiliated hospital of Xi'an Jiaotong University. According to whether hemodialysis and central venous catheterization were performed before PD, these patients were divided into two groups: USPD group (HD-CVC was not performed before PD) and HD-PD group (HD-CVC was given after admission, and then the PD catheterization was performed within 2 weeks ). The follow-up time was 1 year. The differences in clinical biochemical indexes, dialysis dose, urine volume, residual renal function, dialysis adequacy, peritoneal dialysis complications and technical survival rate between the two groups were observed. Results 1.A total of 482 patients were enrolled in this study, including 315 in the USPD group (average age 48.56±14.92 years) and 167 in the HD-PD group (average age 48.87±14.49 years). The demographics and clinical biochemical indexes (including creatinine, glomerular filtration rate, and blood potassium before admission) were similar between the two groups, and the differences were not statistically significant(P&gt;0.05).2. After PD for 1month, residual renal function, UKt/V and TKt/V in the USPD group were significantly higher than those in the HD-PD group, blood urea nitrogen and creatinine were significantly lower than those in the HD-PD group (USPD group: 4.41±4.0ml/min, 0.79±0.44, 2.17±1.39, 17.79±4.96mmol/L, 663.15±182.03umol/L; HD-PD group: 3.67±2.39ml/min, 0.64±0.42, 1.92±0.55, 19.08±8.21 mmol/L, 711.02±280.3umol/L), and the differences were statistically significant (P&lt;0.05, respectively).After PD for 6months, the urine volume in the USPD group were significantly higher than those in the HD-PD group(USPD group:964.84±539.95ml/d; HD-PD group 794.39±569.17ml/d), and the difference was statistically significant (P=0.002). 3. During the whole follow-up period, the exit-site infection rate, peritonitis infection rate, mechanical complications and technical survival rate were similar between the two groups, with no statistically significant difference (P&gt;0.05,respectively). Conclusion Hemodialysis with central venous catheter before USPD affected the residual renal function and dialysis adequacy. HD-CVC as a pretreatment is not recommended to the end-stage renal disease patients who required PD but without the indication of emergency dialysis.

scholarly journals Residual renal function and blood count in patients on continuous ambulatory peritoneal dialysis

2006 ◽  
Vol 134 (11-12) ◽  
pp. 503-508
Author(s):  
Natasa Jovanovic ◽  
Mirjana Lausevic ◽  
Biljana Stojimirovic
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Chronic Renal Failure ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Blood Count ◽  
Residual Renal Function ◽  
Co Morbidity ◽  
Positive Correlations

Introduction:Most of patients with chronic renal failure are affected by normochromic, normocytic anemia caused by different etiological factors. Anemia causes a series of symptoms in chronic renal failure, which can hardly be recognized from the uremic signs. Anemia adds to morbidity and mortality rates in patients affected by advanced chronic renal failure. Blood count partially improves during the first months after starting the chronic renal replacement therapy, in correlation with the quality of depuration program, with extension of erythrocyte lifetime and with hemoconcentration due to reduction of plasma volume. Recent trials found that higher residual renal function (RRF) significantly reduced co-morbidity, the rate and duration of hospitalization and risk of treatment failure. Objective: The aim of the study was to follow blood count parameters in 32 patients on chronic continuous ambulatory peritoneal dialysis (CAPD) during the first six months of treatment, to evaluate the influence of demographic and clinical factors on blood count and RRF, and to examine the correlation between RRF and blood count parameters. Method: A total of 32 patients affected by end-stage renal disease of different major cause during the first six months of CADP treatment were studied. RRF and blood count were evaluated as well as their relationship during the follow-up. Results: Blood count significantly improved in our patients during the first six months of CAPD treatment even if Hb and HTC failed to reach normal values. Iron serum level slightly decreased because of more abundant erythropoiesis and iron utilization during the first six months of treatment. RRF slightly decreased. After six months of CAPD treatment, the patients with higher RRF had significantly higher Hb, HTC and erythrocyte number and a lot of positive correlations between RRF and anemia markers were observed. Conclusion: After 6-month follow-up period, the patients with higher RRF had significantly higher blood count parameters, and several positive correlations between RRF and blood count markers were confirmed.

Clinical characteristics associated with the properties of gut microbiota in peritoneal dialysis patients

2020 ◽  
pp. 089686082097698
Author(s):  
Na Jiang ◽  
Chenhong Zhang ◽  
Hao Feng ◽  
Jiangzi Yuan ◽  
Li Ding ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Gut Microbiota ◽  
Clinical Characteristics ◽  
High Throughput Sequencing ◽  
Residual Renal Function ◽  
Microbial Composition ◽  
Cross Sectional ◽  
Dialysis Duration ◽  
Glucose Exposure

Background: Gut microbiota alters in patients with end-stage renal disease, which contributes to inflammation, atherosclerosis, and results in increased incidence of cardiovascular diseases. The present study investigated the potential clinical factors, which influence the gut microbial structure and function in patients undergoing peritoneal dialysis (PD). Methods: This is a cross-sectional study performed in 81 prevalent PD patients. Gut microbiota was assessed by high throughput sequencing of 16S ribosomal ribonucleic acid gene in fecal samples. Gas chromatography was conducted to measure stool short-chain fat acid (SCFA) concentrations. Demographic parameters and clinical characteristics, including dialysis regimen, residual renal function, nutrition, and inflammation, were retrieved and related to the properties of gut microbiota. Results: PD duration, peritoneal glucose exposure, and estimated glomerulus filtration rate (eGFR) were identified to be associated with microbial variations. Significant separation of microbial composition was shown between patients with short or long PD duration ( p = 0.015) and marginal differences were found between patients grouped by different levels of peritoneal glucose exposure ( p = 0.056) or residual renal function ( p = 0.063). A couple of gut bacteria showed different abundance at amplicon sequencing variant level between these patient groups ( p < 0.05). In addition, stool isobutyric and isovaleric acid concentrations were significantly reduced in patients with longer dialysis duration, higher peritoneal glucose exposure, or declined eGFR ( p < 0.05). Conclusions: This pilot study demonstrated that long dialysis duration, high peritoneal glucose exposure, and loss of residual renal function were associated with gut microbiota alteration and reduced branched-chain SCFA production in PD patients.

scholarly journals Candesartan ameliorates the functional renal disorder in diabetic nephropathy induced by streptozotocin

2014 ◽  
Author(s):  
Marko Kostovski ◽  
Ana Vasileva ◽  
Jasmina Trojacanec
Keyword(s):  
Diabetes Mellitus ◽  
Renal Function ◽  
Urine Volume ◽  
Renin Angiotensin System ◽  
Body Weight Loss ◽  
Renal Disorder ◽  
Angiotensin System ◽  
Urine Albumin ◽  
At1 Antagonist ◽  
Symptoms And Signs

Background Diabetic nephropaty (DN) occurs in approximately 40% of patients with diabetes mellitus, and is the most common cause of end-stage renal disease. The mechanisms of DN are not very clear more recently, but the renin-angiotensin system (RAS) plays an important role. It has been known that rennin-angiotensin system blockers have a renal protective effect. The present study was undertaken to evaluate the effects of the candesartan on functional renal tests in streptozotocin (STZ) induced DN in rats. Methods DM was induced by a single intraperitoneal injection (ip) injection of STZ (60 mg/kg). In order to develop DN the animals were left in diabetic condition during 4 weeks. The DM rats were randomly assigned to the two experimental groups (STZ and STZ+CAN). To estimate the symptoms and signs of DN, the STZ group of rats was left without treatment. For assessment of the effects of the AT1 antagonist, candesartan (CAN) (5 mg/kg/day) was administered from week 4 to week 12. Renal function was assessed by determination of serum creatinine, blood urea nitrogen (BUN) test, 24-hour urine volume and urine albumin. Results The administration of STZ have caused diabetes mellitus (DM) with symptoms and signs of DN including poor general condition, body weight loss, as well as abnormalities of serum and urinary renal function tests. In STZ group of rats, these symptoms have been more distinctly 8 and 12 weeks after administration of STZ. Conclusion The candesartan treatment, although not completely but to a great extent ameliorates the functional renal disorder induced by STZ and may be used as a first line drug in preventing DN.

scholarly journals Profile of Diabetic Nephropathy in Southern Morocco

2021 ◽  
Author(s):  
SANAA BENBRIA ◽  
Abdelaali BAHADI ◽  
Youssef ZORKANI ◽  
MOUNIA AZIZI ◽  
yassir zajjari ◽  
...  
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Diabetic Nephropathy ◽  
Renin Angiotensin System ◽  
Biological Data ◽  
Diabetic Patients ◽  
Early Management ◽  
Angiotensin System ◽  
Renin Angiotensin

Abstract Diabetic nephropathy (DN) has a steadily increasing prevalence, particularly because of the increase in sedentary lifestyle and obesity. It is defined as the persistent presence of albuminuria in a diabetic patient and requires early management to prevent progression to end-stage renal failure. The purpose of this work is to describe the epidemiologic profile and the progression of DN for the first time in a southern Moroccan region: Guelmim Oued noun - Moroccan Sahara.Patients and methods: It is a retrospective study conducted at the 5th military hospital in Guelmim and including all diabetic patients seen in nephrology consultation between January 2015 and December 2018. We collected the following parameters of our patients: demographics, comorbidities, prescribed treatments and biological data (Albuminuria, renal function and glycated hemoglobin) during their nephrology follow-up.Résults: During the study period 267 diabetic patients were included among 1042 patients, which represented 25.9% of the nephrology consultation activity. Their average age was 64.3 years with a slight male predominance (60%) and only two patients had type 1 diabetes. At the first nephrology consultation the average duration of diabetes was 14.6 years, 61 (22.8%) patients were on diet alone, 95 (35.5%) on oral antidiabetic drugs (OADs), 94 (35.2%) on insulin and 35 (13%) on OAD and insulin. Half the patients were hypertensive and 107 (40%) already had a cardiovascular complication (arterial disease, coronary artery disease or stroke). The average initial albuminuria was 388 mg/24h and the average glomerular filtration rate (GFR) was 67 ml/min ; 115 (43%) patients being in renal failure. 46 (17%) patients had no renal function assessment during their previous follow-up and only 139 (52%) were on renin-angiotensin system inhibitors (RASIs). After 12-month-follow-up in nephrology, the average GFR was 70 ml/min and 64 ml /min after two years.Conclusion: Diabetic nephropathy accounts for at least a quarter of nephrology consultation activity in the region of Guelmim Oued Noun. It is characterized in this context by the delay in treatment using renin angiotensin system inhibitors and late nephrology referral hence the need to strengthen preventive strategies in this region especially continuous training.

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